NYC's Success Reducing Unintended Births is at Risk

Many people think teens have the highest risk for unintended pregnancies. But they don't. Across the country, women in their 20s account for 54 percent of unintended pregnancies.

If the U.S. Supreme Court's decision in the Hobby Lobby case wasn't disturbing enough, this shows just how out of touch the decision is with the reality of women's lives and health.

In New York City, women in their 20s account for an even higher percentage of unintended pregnancies than in other parts of the country. Of all pregnancies in NYC, 61 percent are unintended. Thanks to many years of innovative, successful initiatives to reduce teen pregnancy rates and wider availability of contraceptives, NYC's teen pregnancy rate dropped an astounding 30 percent from 2003 to 2013. But the rate for women in their 20s remains high.

This is why it is critical that women of all ages have access to affordable birth control, an essential part of women's basic preventive health care. The vast majority of women spend more than three decades of their lives trying to avoid pregnancy. Ninety-nine percent of sexually active women will use birth control at some point in their lifetime.

Yet the U.S. Supreme Court's misguided decision gave bosses of private, closely held, for-profit corporations the right to deny their employees insurance coverage for birth control because of the boss’ personal objections—even if those objections are not supported by science or medicine. The Court's majority seems to have a complete lack of knowledge about how birth control works and the economic impact a lack of access to birth control can have on a woman. It is troubling that the majority seems to think that contraceptive use—particularly the intrauterine device (IUD)—is somehow controversial in 2014.

The IUD is one of the most effective forms of birth control. Fewer than one out of 100 women will get pregnant each year if they use an IUD. IUDs are effective for five to ten years. They have become a popular option for many women, but high upfront cost has often created a serious barrier to more widespread use.

Women’s increased access to long-acting reversible contraceptives like the IUD has a remarkable impact on reducing unintended pregnancy. A recent study in Colorado showed that providing low-cost or free long-acting birth control like IUDs reduced teen pregnancy by 40 percent between 2009 and 2013. The Colorado Family Planning Initiative provided more than 30,000 IUDs or implants at low or no cost to low-income women at 68 family planning centers across Colorado beginning in 2009. The decline in births among young women served by these agencies accounted for three-quarters of the overall decline in the state's teen birth rate. More important, the initiative has helped thousands of young women continue their education, pursue their professional goals and postpone pregnancy until they are ready to start a family.

What made Colorado’s initiative a success? Removing the IUD's upfront cost barrier—an option the female employees at Hobby Lobby no longer have. In Justice Ruth Bader Ginsberg’s stinging dissent, she discussed the economic hardship created when women are forced to pay for contraception out of pocket, stating “the cost of an IUD is nearly equivalent to a month’s full-time pay for workers earning the minimum wage.”

New York City and New York State recognize the importance of breaking down the barriers to birth control methods—not only for teens but for all residents. In 2012, the city established the IUD Task Force, an initiative that includes more than 50 medical providers, educators, administrators, public health professionals, reproductive health advocates, and researchers from more than 25 city-based organizations, including Planned Parenthood of New York City (PPNYC). The Task Force aims to ensure that everyone has access to a full-range of contraceptive methods, including highly effective methods like the IUD. This July, New York State revised a Medicaid policy to allow reimbursement for IUD insertion after childbirth in hospitals' labor and delivery wards—a critical time for family planning.

These efforts will go a long way to helping women gain access to a highly effective birth control method that works for them and their lives, and not one based solely on what they can afford. Publicly funded family planning services play a crucial role in reducing unintended pregnancies. The rate of unintended pregnancy in the United States in 2012 would have been 44 percent higher without publicly funded family planning services, according to new research from the Guttmacher Institute. Women need more access to birth control methods, not less.

Here at PPNYC, we work every day to ensure that our patients have access to affordable, reliable birth control. We have entitlement counselors onsite at all our health centers to help women enroll in Medicaid and other affordable health insurance plans that provide coverage for FDA-approved methods of birth control. Our "I'm on it" campaign inspires women and women to take control of their futures by choosing a birth control method that is right for them and using it consistently. The campaign is part of the larger “Building Healthy Futures: The Campaign to Prevent Unintended Pregnancy in New York City,” with founding partners the Bronx District Public Health Office - New York City Department of Health and Mental Hygiene, The Bronx Health Link, Hostos Community College, Montefiore Medical Center, PPNYC, and the Women’s Housing and Economic Development Corporation (WHEDco).

PPNYC health centers also have free or low-cost IUDs available for patients who are uninsured or face financial hardship, eliminating the upfront cost barrier for some of the women who most need care. In 2013 alone, more than 5,600 clients at our health centers opted for a long-acting reversible contraception method like the IUD.

Despite the terrible blow by the Supreme Court, we will continue to fight for affordable access to birth control methods. In the meantime, we will keep working every day to ensure that all women in this great city have access to the full range of reproductive health care services—no matter where they work.